A

LETTER

ΤΟ

SIR WILLIAM GARROW,

HIS MAJESTY'S ATTORNEY-GENERAL,

ON

HIS PROPOSED BILL FOR REGULATING THE PRACTICE OF SURGERY THROUGHOUT THE UNITED KINGDOM

OF GREAT BRITAIN AND IRELAND.

BY

JAMES HAMILTON, M. D.

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH, AND PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH.

This Bill did not pass into a Law.

SECOND EDITION.

LONDON:

A LETTER,

&c. &c.

SIR,

HAVING learned, within these few days, that it is your intention again to bring before Parliament a Bill "To Regulate the Practice of Surgery throughout the United Kingdom of Great Britain and Ireland," I beg leave to submit to your serious consideration the following Remarks on that part of your intended Bill which relates to the practice of Midwifery. And in entering upon this discussion, it is proper to premise, that I do not voluntarily obtrude my sentiments upon the measure in question, but that Í fulfil a duty imposed upon me by my official situation as Professor of Midwifery in the University of Edinburgh.

The fifth clause of your Bill is in the following words. "Whereas Surgical aid is frequently required in Midwifery, and it is expedient that male persons so practising should be qualified to render such aid; be it therefore enacted, that from and after it shall not be lawful for any male person to practise Midwifery, unless he shall have obtained a Diploma or Testimonial to practise Surgery under the Seal of one of the said three Royal Colleges, or unless he shall have obtained a Testimonial of qualification as a principal Surgeon in the Army or Navy, and shall have actually served in that capacity."

This clause is intended to restrict the Practice of Midwifery to Surgeons, and therefore it is incumbent on the proposer of the Bill to satisfy the legislature that such a restriction is consistent with established usage, or that it is necessary or expedient.

After arts and professions became distinct branches of human industry, a division took place among those who practised the

Healing art, into Physicians and Surgeons; and at that time, and for some centuries afterwards, it was supposed that the respective duties of Physicians and Surgeons could be accurately defined.

In the original Charter of the Royal College of Surgeons of Edinburgh, the Members of that College are exclusively empowered to perform all Surgical operations, and are positively prohibited from practising in any other than external diseases or accidents. On the other hand, by the Charter of the Royal College of Physicians of Edinburgh, the practice in all internal diseases is exclusively assigned to the members of that College.

Notwithstanding the explicit terms of those Charters, the Members of the Royal College of Surgeons actually at present engross nine-tenths of the Practice of Physic in Edinburgh; and if the Members of the two Colleges were to bring the question of their respective privileges under the review of a court of law, it would probably puzzle the Lord Chancellor himself to determine what are internal and what are external diseases, that is, what diseases are owing to some internal change in the human body beyond the control of Surgery, and what diseases arise from some affection which the art of Surgery might arrest in its progress, or might remove.

It is now well understood, that a Physician, without a knowledge of the principles of Surgery, might commit the most serious errors in the management of many diseases; and that a Surgeon, unacquainted with the Practice of Physic, could not conduct a patient safely through the consequences of an important operation. But, wherever the opulence of a particular community is such as to allow of a minute subdivision of labor, medical men, after having studied both Physic and Surgery, must find it their interest, according to their individual genius, to confine themselves to practise in diseases affecting the general constitution, as fever, &c. or in disorders requiring a Surgical operation.

For a long time after Physic and Surgery were thus practised by different individuals, the superintendence of the act of Childbearing was entrusted exclusively to women, except in those rare cases of extreme difficulty and danger, where a mechanical operation was required, when recourse was had to the assistance of a Surgeon.

But towards the end of the seventeenth century, certain Surgeons in Paris began to devote their time and attention to the charge of pregnant women; and soon afterwards a similar subdivision among Medical Practitioners took place in London, with this difference, however, that the individuals who made Midwifery an exclusive profession in that city were Physicians,-and hitherto the Chief practitioners, and Teachers of Midwifery in London have been Physicians.

Thus, in the reign of King Charles II. Dr. Chamberlain became eminent as a Practitioner of Midwifery, and invented an instrument, by which the infant can be extracted alive, without injury to the parent, in cases where it was formerly deemed absolutely necessary to sacrifice one life. Dr. Chapman, who first taught Midwifery in London, lived about the beginning of the eighteenth century. He was succeeded by Dr. Smellie, who improved greatly upon the French mode of teaching, and whose Works are still deservedly held in much estimation. Dr. William Hunter followed Dr. Smellie, and published a Set of Plates, illustrating, the Anatomical Structure of the Gravid Uterus, which may be said to have laid the foundation of some of the most important improvements in the Practice of Midwifery. After Dr. Hunter's time, several Physicians, among whom may be enumerated the names of Dr. Colin Mackenzie, Dr. Orme, Dr. Lowder, Dr. Denman, Dr. Garshore, Dr. Osborne, Dr. Clarke, Dr. Thynne, Dr. Bland, and many others, practised or taught Midwifery in London with high reputation, and, by their writings, improved very greatly the principles of the Profession.

That in country districts and provincial towns, Surgeons and Apothecaries have practised Midwifery, is unquestionable, and can be easily explained; for it is obvious, that a minute subdivision of occupations cannot be encouraged in such places. But in the other two capitals of the empire, ever since medical men were employed to attend women in labor, viz. for the last sixty years, Physicians have practised Midwifery. In Edinburgh, Dr. Young, Dr. Alexander Hamilton, Dr. Gillespie, Dr. Stuart, and the present Professor of Midwifery; and in Dublin, Dr. Macbride, Dr. Cleghorn, Dr. Clarke, Dr. Évory, and several other Physicians, might be named.

It is therefore incontrovertible, that in the united empire, according to usage, Physicians have devoted themselves to the Practice of Midwifery in those situations where a subdivision of the duties of the Profession could be advantageously established.

Unless it could be proved, that the employment of Physicians in the Practice of Midwifery has been injurious to society, the necessity or expediency of altering this usage by Legislative interference cannot possibly be maintained. But a very little inquiry into the subject must convince every unprejudiced person, that this usage has been of material benefit to the public.

In France, where the profession of Midwifery is exercised by Surgeons, scarcely any other improvement has taken place, than what relates to the mechanical department. But in Great Britain, in consequence of Physicians directing their attention to the Practice of Midwifery, the nature and the treatment of the various

complaints to which women and children are liable, have been carefully investigated; and it can be satisfactorily shown, that within the last forty years, the Medical practice in those diseases has been infinitely more improved than in any other class of disorders. Among several proofs which might be drawn from the Bills of Mortality of London, the following may be selected.

Table of the Average Number of Deaths in Child-bed in London, taken from the Bills of Mortality."

For 4 years, ending in 1660, 1 in 36.

10

1670,

39,

The improvements in the treatment of the diseases of women and infants, thus suggested and introduced by Physicians practising Midwifery, have not been the result of superior genius, but have proceeded from such Physicians directing their attention to a particular class of diseases. Those improvements could not have been misunderstood by a nation whose superiority in arts and manu factures depends so much upon the subdivision of labor; and accordingly such encouragement has been given to the Profession of Midwifery, in the extended sense of the word, that the mechanical duty, notwithstanding its importance, and its difficulty on some occasions, forms only a part, and a small part too, of the occupation of Practitioners of Midwifery in large cities.

It is a curious, and an instructive fact, that in proportion as Physicians practising Midwifery in London have acquired the confidence of the public, they seem to have become the objects of distrust to the Fellows of the Royal College of that Metropolis; so that, as their public usefulness has increased, their exertions have been fettered by the Royal College, till at last an attempt is VOL. XII. Pam. NO. XXIII.

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